Synthesis and characterization of an experimental primer containing chitosan nanoparticles - Effect on the inactivation of metalloproteinases, antimicrobial activity and adhesive strength.

OBJECTIVE: The aim of this study was to synthesize and characterize an experimental primer containing cationic lipid nanoparticles (NPL-chitosan) and to evaluate its properties. DESIGN: The NPL-chitosan were synthesized by emulsion and sonication method. The experimental primers were applied in dentin surface of fifty human molars. The experimental groups were: 1) application of commercial primer; 2) Primer containing 2% of Chlorhexidine (CHX) 3); Primer with 2% NPL-chitosan 4); Primer with 0.6 % of NPL-chitosan 5); Primer with 0.4 % of NPL-chitosan. A composite resin plateau was used for the analysis, where sections were made for making the dentin beams. The effect of experimental primer with cationic nanoparticles in the inhibition of matrix metalloproteinase (MMP) activity was carrying out by in situ zymography. For the Resin-Dentin Adhesive Strength and in situ Zymography analysis, was used the One-way analysis of variance (ANOVA) with significance level of 95 %. RESULTS: Spherical NPL-chitosan presented size below 220 nm, polydispersity index of 0.179 and zeta potential positive and was stable over 75 days. These nanoparticles showed antibacterial activity agsainst S. mutans with MIC of the 0.4 % and MBC of 0.67 %. In the Microtensile Strength, no statistical difference was observed between the experimental groups (p = 0.9054). The in situ zymography assay showed that the group with 2% of NPL-chitosan presented higher inactivation activity of MMPs compared to the other groups (p < 0.05). CONCLUSION: The experimental primer containing NPL-chitosan has antimicrobial activity, does not alter the adhesive resistance and inactivates MMPs present in dentin.

Mathematical modeling of the HIV/Kaposi's sarcoma coinfection dynamics in areas of high HIV prevalence.

We formulate a deterministic system of ordinary differential equations to quantify HAART treatment levels for patients co-infected with HIV and Kaposi's Sarcoma in a high HIV prevalence setting. A qualitative stability analysis of the equilibrium states is carried out and we find that the disease-free equilibrium is globally attracting whenever the reproductive number ℛk < 1. A unique endemic equilibrium exists and is locally stable whenever ℛk > 1. Therefore, reducing ℛk to below unity should be the goal for disease eradication. Provision of HAART is shown to provide dual benefit of reducing HIV spread and the risk of acquiring another fatal disease for HIV/AIDS patients. By providing treatment to 10% of the HIV population, about 87% of the AIDS population acquire protection against coinfection with HIV and Kaposi's Sarcoma (KS). Most sub-Sahara African countries already have programmes in place to screen HIV. Our recommendation is that these programmes should be expanded to include testing for HHV-8 and KS counseling.

[A case report: an university professor suffering from malignant mesothelioma]. / Un caso clinico: un professore universitario affetto da mesotelioma maligno.

During the activities of the Apulia Regional Operative Center (COR Puglia), pertaining to the National Registry of Mesothelioma (ReNaM), there was reported a case of malignant mesothelioma occurred in a male of 66 years old. The case we bring to the attention is about an university professor of chemistry who, since the early '70s, has conducted several studies on the physico-chemical properties of some metals, particulary in the field of thermochemical treatments of superficial hardening of steel for greater wear resistance, using a laboratory with ovens and asbestos-containing materials and consumables. In 2011, after almost 40 years, the subject comes to the attention of the Apulia Regional Operative Center, with histologic and immunohistochemical diagnosis of epithelioid mesothelioma, after completing the diagnostic procedure in a thoracic surgery ward, for the assessment and treatment of a right pleural effusion revealed during health checks.

[Asbestos and agriculture: new perspectives of risk]. / Amianto e agricoltura: nuove prospettive di rischio.

The presence of ophiolites in areas of Basilicata, where there have been reports of mesothelioma in farmers, is known. This study evaluates the increased risk of exposure to tremolite in carrying out agricultural activities. Cases of mesothelioma occurred in farmers with unknown exposure to asbestos have been selected and assessed the employment in areas contaminated by tremolite. Personal samplings were conducted in a group of farmers employed in these areas and a group of subjects used in activities that do not involve contact with the ground. For the 5% of cases of mesothelioma in the lucan register emerged exposure to asbestos exclusively in farming activities in areas at tremolite risk. The analysis of the samples showed the presence of personal fibers of tremolite in 2/3 of the cases. In 60% there was an overcoming of the natural limit of 2 ff/l, with a peak up to 23.6 ff/l. The study shows that the risk of exposure to tremolite in agriculture is significantly higher than natural exposure.

[Exposure to asbestos in buildings in areas of Basilicata characterized by the presence of rocks containing tremolite]. / Esposizione ad amianto in edilizia in aree della Basilicata caratterizzate dalla presenza di rocce contaminate da tremolite.

Lucania, in southern Italy, is characterized by areas with natural outcrops of rocks containing tremolite. The study aims to assess the risk of exposure to asbestos in the building workers in these areas through environmental sampling near sites for implementation of safety of roads built on serpentinite rocks and personal sampling in a group of persons who work in the building industry and a group of residents engaged in activities without contact with the ground. Near road sites was found the presence of airborne tremolite in 66% of environmental samples with peaks up to 31 ff/l. The analysis of personal samples showed the presence of tremolite in doses higher than the natural background in 100% of the building workers, while there were no fibers in the samples of residents employed in activities without soil disturbance. The study shows that the building in areas with naturally occurring asbestos determines a condition of significant occupational exposure to asbestos. Adequate safety measures for workers exposed are needed.

[Dermatopathies in fishmongers in the city of Bari]. / Dermopatie in addetti alla vendita di prodotti ittici nello città di Bari.

The marketing of fish products determines for the fishmongers contact with water, ice and use of sharp tools. This study evaluates the skin reactions after fish handling manipulation in a group of fishmongers. 60 questionnaires were administered for information on seniority, use of IPDs, training received, work injuries and general health. We have performed a physical examination of the fishmongers' hands. 98.3% of workers reported the use of IPDs. During the examination were found dyschromic lesions, freezing and foreign bodies, mainly in those who did not use gloves. The study shows the hands' skin condition in those fishmongers that did not use IPDs. This phenomenom requires formative and informative targeted interventions and stronger oversights.

[Needlestick and sharps injuries among nursing students: an emerging occupational risk]. / Infortuni da dispositivi taglienti tra gli studenti di infermieristica: un rischio lavorativo emergente.

The biohazard represents a major occupational risk among workers in the health sector, this risk is not only exclusive for healthcare workers but involve also nursing students. The study reports data of a survey on injuries from accidental puncture in a group of 223 students of the third year of Nursing of Bari University. The 18% of students say they have suffered over the past 12 months an accidental puncture with sharp instruments. The cutting device most frequently involved is the needle from the syringe and insulin. The most at risk are the recovered and disposal of the needle. The biohazard in training is further compounded by factors such as lack of experience and skill manuals consolidated combined with a non perception of the risk. In the obligation of protection, training and information to students of Nursing, the University must implement programs aimed at both knowledge of the risks to which they are exposed, as well as security procedures to contain an emerging risk, which one of injury from sharp instruments, which are exposed young students not yet in employment.

[Adenocarcinoma of the nose after occupational exposure to wood dust: description of a case]. / Esposizione lavorativa a polvere di legno ed adenocarcinoma primitivo dei seni paranasali: descrizione di un caso.

UNLABELLED: The occupational exposure to wood dust, classified by IARC as carcinogenic certain may determine the onset of epithelial tumors of the mass graves and nasal sinuses. The symptoms of these malignancies are aspecific (nasal obstruction, rhinorrhea), the diagnosis is often delayed. CLINICAL CASE: Worker of 59 years occupied, from 1960 to 2005, in carpentry (construction of coffins), who died in 2006 for a nasal adenocarcinoma of the mass graves extended to the cranial base, initially considered intracranial cancer given the wide cranial fossae prior to the histological diagnosis. The case is emblematic to late diagnosis and long survival (the worker has survived for more than three years after TAC diagnosis of intracranial mass occurred in 2003). CONCLUSION: Extending the cranial base of a cancer of the nose and sinuses occurred in a worker exposed to wood dust is a serious critical in the system of health surveillance in the company. This rare neoplasm is a "sentinel event" that highlights a problem of underestimation of this occupational tumor and consequent failure of occupational disease complaint is therefore required a careful accounting and reporting of cases.

Instruments for assessing quality of life in palliative care settings.

Quality of life is an outcome that is particularly important during palliative care. However, in order to measure this outcome, it is necessary to have a valid and reliable measure. The purpose of the article was to identify and describe quality of life measures that are appropriate for use in palliative care settings. Characteristics that are believed to be critical for quality of life instruments include the following. The instrument should: (1) be multidimensional; (2) provide self-report data; (3) be useful in the setting in which it is to be used; (4) be valid and reliable for use in palliative care settings. The five scales described measure a variety of dimensions including physical, psychological, social, spiritual, existential, support, symptoms and functional aspects of quality of life. All but one are self-report instruments. All have evidence of validity and reliability for use with palliative care populations.

Meeting the challenge of unscheduled outpatient visits.

Cancer patients receive multimodal therapy and treatments on an ongoing basis in free-standing cancer centers, infusion centers, and oncology offices and at home. To serve those who require unscheduled evaluation for treatment effects, one hospital developed a program to receive those visits on an inpatient cancer unit.

A professional practice model: two key components.

Professional practice models provide decentralized approaches to nursing practice. The components of such a model should include a primary nursing delivery system, decentralized decision making, salary compensation, self-scheduling and quality circles. This article describes two of the key components of the model--salaried compensation and self-scheduling--on a unit in one agency.

Management of hypoplastic left heart syndrome in a consortium of university hospitals.

To determine current management of hypoplastic left heart syndrome, we utilized the discharge database of the University Hospital Consortium and obtained data on the surgical procedures, length of stay, hospital charges, and outcome for 636 neonates with this condition admitted to 40 member institutions from 1989 to 1993. Of the 636 patients, 95 (15%) were discharged without surgical intervention. A Norwood operation was performed in 222 (53% mortality) and transplantation in 40 (42% mortality). Median length of stay and hospital charges were 17 days and $57,418 for the Norwood procedure and 47 days and $126,695 for transplantation.

Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company.

The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

Introducing physician order entry at a major academic medical center: II. Impact on medical education.

The introduction of an information technology (IT) system that mandates order entry by physicians had significant and often unexpected effects on medical education at the University of Virginia Medical Center. The system was deactivated briefly after the introduction of laboratory ordering, and frustration with the pharmacy ordering pathways provoked a major confrontation between the residents and medical center management. With time and experience, however, the housestaff have adjusted to the system and developed facility in using it. Much of the dissatisfaction was derived from the perception that "doctors spend too much time on the computer." In fact, less than 10% of the physicians spent more than an hour each day. However, a small group of residents on call for the busier services were sometimes at the computer for more than four hours each day. Changes in responsibilities, patterns, and priorities of work introduced by the system also contributed significantly to the general dissatisfaction. These issues had not been thoroughly considered in the planning stage, but it was only after accommodation was made to these changes that integration of the technology into routine practice could proceed. The author emphasizes the importance of extensive involvement and leadership of attending physicians in the planning and implementation of such a system. He presents a set of recommendations to those considering similar IT initiatives and wishing to reduce the disruptions that may accompany their introduction.

Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior.

In 1988 the University of Virginia Medical Center began implementation of a medical information system based on mandatory physician order entry. The implementation process was much more difficult than expected. The program experienced considerable delays, and cost much more than was originally estimated. Although there were some legitimate questions concerning the user-friendliness of the new technology, these were less significant than the cultural and behavioral problems encountered. The new system challenged basic institutional assumptions; it disturbed traditional patterns of conduct and forced people to modify established practice routines. Real progress toward the integration of the system into the center's operational culture occurred only after a senior management team representing important sectors of the hospital staff and administration began meeting regularly to address the institution-wide issues that had been raised. The author describes the problems that occurred and the organizational behaviors on which they were based, analyzes the lessons learned, documents the progress that has been achieved, and outlines the challenges that remain. The center's experience provides insight into the issue of technology-driven organizational transformation in academic medical centers. Recommendations for successful introduction of similar agents of institutional change are presented.

Impact of new technologies on health-care costs and on the nation's "health".

By virtually all criteria, the American health-care system has the largest and most widely distributed technology base of any in the world. The impact of this emphasis on technology on the cost of care, the rate of health-care inflation, and the well-being of the population is reviewed from the perspective of the patient, the provider, and the public health analyst.

Interactions between lead and essential elements: a review.

Young children are especially susceptible to the toxic effects of lead. Although the effects of overt lead intoxication have been well studied, critical information on the long-term effects of low level lead exposure is lacking. The results of recent clinical studies indicate that "chronic" low level lead exposure during development can result in behavioral alterations in the absence of overt neurotoxicity. The perturbation of central nervous system functioning may be the result of essential mineral deficiencies resulting from lead-induced impairment of mineral availability and/or an increased sensitivity to lead in the absence of adequate levels of essential minerals. This article reviews research undertaken to examine the interactions between calcium, iron, zinc, copper and lead with reference to how this may impact central nervous system functioning.